Factors Associated with Alcohol Withdrawal or Alcohol-Withdrawal Delirium among Inpatients with Alcohol Use in a General Hospital Setting: A Comparison Before and During the COVID-19 Pandemic

The present study aims to identify the risk factors related to alcohol withdrawal syndrome or alcohol- withdrawal delirium (delirium tremens) in patients with alcohol dependence admitted to a general hospital during the coronavirus disease 2019 and non-coronavirus disease 2019 periods. A retrospective chart review of patients diagnosed with alcohol dependence and admitted to a general hospital pre- and post-coronavirus disease 2019 outbreak was conducted. In both datasets, clinical and laboratory information from eligible medical records were reviewed and compared between two groups: an alcohol-dependent group without alcohol withdrawal syndrome or delirium and an alcohol-dependent group with alcohol withdrawal syndrome or delirium. Clinical or laboratory risk factors related to alcohol withdrawal syndrome were analyzed using Pearson's chi-square test, t-test, odds ratio, and logistic regression analysis for each dataset. The p value for statistical significance was set at .05. The results show a total of 626 alcohol-dependent inpatient charts were reviewed, consisting of 249 cases of alcohol withdrawal syndrome or delirium tremens, which was defined as a positive disease outcome (first dataset: 89/200 total cases; second dataset: 160/426 total cases). Abnormalities in serum aspartate aminotransferase levels greater than 1.5 times the upper normal limit and psychiatric consultation were strongly related to alcohol withdrawal syndrome or delirium tremens, whether coronavirus disease 2019 was in effect or not. Regarding the sub-analysis of related factors, abnormalities in serum sodium and potassium levels and a history of alcohol withdrawal were significantly related to alcohol withdrawal syndrome or delirium tremens in the first set, while abnormalities in serum aspartate aminotransferase and psychiatric consultation were significantly related to alcohol withdrawal syndrome or delirium tremens in the second set. In conclusion, alcohol withdrawal and delirium tremens are serious but preventable complications in hospitalized patients with alcohol dependency. Clinicians should be alerted by increased serum aspartate aminotransferase, an abnormality in serum sodium or potassium, or a previous history of alcohol withdrawal symptoms.